WATKR"' SUPPLIES* (Chapter from the Forthcoming Report of the Committee otn Muitnicipal Hcalth Departmentt Practice)

Transcription

1 WATKR"' SUPPLIES* (Chapter from the Forthcoming Report of the Committee otn Muitnicipal Hcalth Departmentt Practice) OWNERSHIP In 1 of the 83 cities studied' the water supply is owned by a private company, in 3 by the Metropolitan Board of Boston,2 and in the remaining 69 by the municipality itself. CONTROL, In none of the 83 cities is the water plant operated by the health department. The degree of control exercised by the health department varies widely. In 31 cities no control is exercised by the municipal health department.3 In the case of 24 of these 31 cities, however, the state department of health maintains close supervision over municipal water supplies. This is notably true of cities in Massachusetts, Pennsylvania, Ohio, California, Michigan and Minnesota. Of the remaining 52 cities, information is not available regarding 5.4 The degree of control exercised by the remaining 47 is as follows: "Controls" 3 cities,3 "Advises or Supervises" 6 cities.6 In 4 cities, Atlanta, Cincinnati, New York and Richmond, the health department "Cooperates" in the control of the water works. In 3 cities, Portland, Scranton and Seattle, the health department maintains patrol of the watershed, Scranton and Portland conducting analyses in addition to the patrol. In 3 cities the health department laboratory makes analyses of the city water supply. In 3 cities, Jacksonville, Savannah and Syracuse, the health department makes all analyses. In 8. cities, Buffalo, Cleveland, Dallas, Day- *Prepared by Allen W. Freeman, M. D., Johns Hopkins University, Baltimore, Md. 1. San Francisco. Indianapolis, Birmingham, Bridgeport. Elizabeth, New Haven, Oakland, Paterson, San Antonio, Scranton and Utica. 2. Boston, Lynn, Somerville. 3. Los Angeles, San Diego, San Francisco. Wilmington, Washington, Kansas City, Kansas, Boston, Cambridge, Fall River, Lawrence, Lowell. Lynn, New Bedford, Somerville, Worcester, Flint Kansas City, Missouri, St. Louis, Omaha, Camden, Akron, Canton, Columbus. Toledo, Reading, Duluth Minneapolis, St. Paul, Providence, Fort Worth, Sp'okane. 759 ton, Indianapolis, Milwaukee, Yonkers, Youngstown, analyses are made daily; in 2, Louisville and New Haven, analyses are made weekly; in the remaining 177 the frequency is not stated or is longer than one week. CHARACTER OF SUPPLY The number of cities having. water supplies from underground, surface and mixed sources, with the populations served, and subdivided according to the method of treatment is shown in the accompanying table. According to this table, 12 cities use water from underground source exclusively, of which 11 are from wells,8 and one, Des Moines, from infiltration galleries in a river. The 64 cities using water from surface sources are supplied: 26 from rivers; 3 from lakes, ponds and impounding reservoirs; 7 from the grreat lakes, and 1, Albany, from a mixture of river and lake water. Mixed underground and surface waters are supplied to 7 cities. Altogether 4.9 per cent of the total population of the cities surveyed iuse water from underground sources, 88.6 per cent use water from surface sources, and 6.5 per cent are supplied with mixed surface and ground water. TREATMENT OF WATER Of the 83 cities only 9 cities serving 4 per cent of the total population use water without some form of treatment. Eight of these supplies are from wells and one, Portland, from mountain 4. Denver, Erie, Elizabeth, Patersoni, Trenton. 5. Detroit, Newark, Utica. 6. Baltimore, Hartford, Houston, Salt Lake City, Memphis, Schenectady. 7. Albany, Birmingham, Bridgeport, Des Moines, Grand Rapids, Jersey City, Nashville. New Orleans, Norfolk. Oakland, Oklahoma City, Philadelphia. Pittsburgh, Rochester, San Antonio, Springfield, Tacoma. 8. Memphis, San Antonio, Dayton, Houston, Camden, Lowell. Spokane, Jacksonville, Schenectady, Canton, Savannah, Portland. 9. San Antonio, Houston, Camden, Lowell, Spokg,ne, Schenectady, Canton and Savannah.

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3 streams from an uninhabited watershed. Storage is the principal method of treatment in 18 cities, serving 32.8 per cent of the population. Of these, 7 use storage alone" and 11 use chlorination in addition.2 Chlorination alone is relied on by 8 cities servinig 17.8 per cent of the population. Of these, 2, Jacksonville and Dayton, are well supplies, one, Des Moines, from infiltration galleries, and five, Clhicago, Detroit, Buffalo, Milwaukee and Duluth, fronm the Great Lakes. Four cities serving 4. per cent of the population use chlorine for part of the year or for part of the supply.' Coagulation with alum or lime, followed by sedimentation and chlorination, is used in 7 cities, serving 6.4 per -cent of the population. Of these supplies 6 are from rivers,4 while one, San Diego, is an impounded supply. Coagulation, sedimentation and rapid sand filtration followed by chlorination is the method of treatment in 22 cities, representing 15.7 per cent of the population of the group.5 Slow sand filtration plants serve 1 cities having 13. per cent of the total population. Of these, 9 use chlorination as a final treatment" and only one, Springfield, is not chlorinated. In five cities having 6.3 per cent of the population of the group, the supply is taken from two or more sources which are treated differently. In Cleveland all the water is taken from Lake Erie, but part of the water is filtered by rapid sand filters and chlorinated, while part is served to the consumers after chlorination alone. In Los Angeles part of the water is taken from infiltration galleries and supplied without treatment, while part from impounded streams is treated by storage. An additional supplementary supply is chlorinated before distribution. 1. Boston, San Francisco, Worcester, New Bedford, Fall River, Lynn anid Somerville. 2. New York, Newark. Seattle, Jersey City, Syracuse, New Haven, Bridgeport, Hartford, Cambridge, Tacoma, Utica. 3. Salt Lake City, Los Angeles, Memphis anl Rochester. WATER SUPPLIES 761 In Indianapolis part of the supply is derived from wells and delivered without treatment, while another part is filtered by slow sand filters and chlorinated. In Denver the supplies from three different sources are all treated differently, 1 per cent of the supply being taken from infiltration galleries is distributed without treatment, while 2 per cent from surface streams is treated by slow sand filters, and 7 per cent of.the total is treated by rapid sand filters. Liquid chlorine, hypochlorite of lime and "chloramine" are used for final disinfection. In St. Paul part of the supply is derived from wells and part from lakes. The lake supply is chlorinated. LABIORATORY CONTROL AND TREATM ENT Of the 83 cities, 69 either have a laboratory at the water plant or other arrangements for daily laboratory examination of the raw and treated waters. This includes all rapid and slow sand filtratiori plants except the rapid sand plant at Oklahoma City, which is said to be without laboratory control of any kind. It also includes all coagulation and sedimentation plants and numerous plants depending on storage, chlorination or both. Of the 14 cities without laboratory control, Oklahoma City has already been referred to. Four well supplies used witlout treatment are without laboratory control. Examinations are said to be made every three months by the state of the Camden well supply, every month of the Houston well supply, weekly of the Spokane well supply, and never, except when new wells are drilled, at Canton, Ohio. The stored supplies of the Massachusetts cities are controlled by the state, laboratory examinations being made monthly. This includes Worcester, New Bedford, Fall River, Cambridge and 4. St. Louis, Kansas Citv. Mo., Omaha, Birminglham Richmon(l. alnd Nashville..,. Baltimore, Cincinnati, New Orleans, Minneapolis Toledo, Columbus. Louisville, Akron, Atlanta, D)allas(Grand Rapids Paterson, Youngstown, Trenton, Norfolk, Wilmington. Fort Worth, Kansas City, Kasns., Elizabeth. Erie, Flint and Oklahoma City. 6. Philadelphia, Pittsburg. Washington, Providence, Scranton, Albany, Reading, Yonkers, Lawrence.

4 762 THE AMERICAN JOURNAL OF PUBLIC HEALTH Lynn. Syracuse and Rochester, N. Y., report that their supplies, from storage, are examined twice weekly. The San Francisco stored supply is examined monthly, and the Seattle stored supply is examined weekly. DISTRIBUTION OF PUBLIC WATER SUPPLIES Information is available as to the percentage of the population of 82 of the surveyed cities furnished with the public supply. In 29 cities the public water supply is used by 1 per cent of the population and in an additional 26 cities the percentage is 95 or more. This includes practically all of the larger cities of the countrv. In 15 cities' the population supplied is between 9 and 95 per cent. In 6 cities2 the percentage supplied is between 8 and 9. In Oklahoma City of this group, however, while the public water supply is distributed to 84 per cent of the population, only 3 per cent are said to use it for drinking. In 5 cities3 the percentage of population using is between 7 and 8. In Kansas City, Kans., the public water supply is distributed to 68 per cent of the population. CONSUMPTION OF WATER The figures for consumption of water are available for 68 of the 83 surveyed cities. Daily per capita consumption varied between 49 gallons for Lawrence to 2959 gallons for Chicago. Other cities with low rates of consumption are Oakland, 5 gallons; Fall River, 53 gallons; Dallas, 62 gallons; Des Moines, 68 gallons; San Francisco, 7 gallons, and Worcester, 75 gallons. Rates of consumption of 2 gallons per capita per day and over were as follows: Savannah, 2; Spokane, 21; Buffalo, 229; Tacoma, 23; Salt Lake City, 235, and Chicago, 259. Of the 68 cities for which the information is avail- 1. Cincinnati, Denver. Toledo. Oakland. Omaha, Richmond, Dallas, Dayton, Houston. Grand Rapids, Youngstown, Des Moines, Reading, Tacoma, Flint. 2. St. Paul. San Antonio, Nashville, Salt Lake City, Duluth, Oklalhomna City. 3. Washington, Indianapolis, Akron, Fort Worth, Jacksonville. able, 47 had a daily per capita consumption of between 75 and 15 gallons. PRIVATE WATER SUPPLIES The data regarding private water supl)lies are not sufficiently detailed to make a statistical analysis possible. In most cities in which there are any considerable number of private wells some effort is apparently made to control the quality of these supplies. Data as to the actual number of private wells, and the quality of the water supplied by them, are not available for any considerable number of cities. Similar conditions prevail in regard to the vended bottled waters. DISCUSSION The water supplies of the 83 cities surveyed are predominantly owned by the municipalities themselves. The relationship of the water supply to the health of the community using it is so direct and of such tremendous importance that it is necessary that the responsibility for the water supply be borne by the muncipality. Control over the public water supply is not usually a function of the health department. It is predominantly an engineering procedure and should be, as is usually the case, a separate department of the city government. The health department should, however, advise with tbe authorities in control of the supply and slhould, except in unusual cases, check the quality of the water by regular and frequent analyses. This is found to be the case in the majority of the cities studied, and in the remainder the control exercised by the state is usually close and accurate. The public supplies of the 83 cities are for the most part derived from surface soturces and are treated in a wide variety of ways. Chlorination as a final treatment is used in almost all the cities stuidied. Tile stored supplies of Massachusetts and a few well supplies of the iliddle west are almost alone in being used without chlorine. The plants are as a rule under close

5 laboratory control. This applies to all slow sand filters, all rapid sand filters except one, all coagulation and sedimentation plants and to a number of the well supplies and storage systems. The stored systems o.f Massachusetts are not usually under local control, monthly analyses by the state being deemed sufficient. The adequacy of this system is apparently demonstrated by the low prevalence of typhoid fever in these cities. The variations in water consumption ai C 'extreme and would appear much larger than the difference in legitimate demand would justify. Metering of the consumers in the cities with excessive WATER SUPPLIES 763 consumption would probably decrease the per capita waste without affecting the use of water for all necessary or desirable purposes. The distribution system of the older eastern cities and of many of the other cities is complete. In a number of cities, however, the public supply fails to be used by a large per cent of the population. Regulation of private wells and springs and of vended waters does not seem to be a practicable procedure. The discussion of typhoid fever in relation to the character of the water supply will be taken up in the section on communicable diseases. Training for Hospital Social Work The New York School of Social Work offers this year a course of training for hospital social work, which includes the following subjects: Health and Nutrition with especial' reference to child hygiene, given by Dr. A. M. Stevens; Problems of Disease by Dr. Samuel Bradbury; History and Organization of Medical and Nursing practice, Dr. George Bigelow; Public Health, by Dr. Michael M. Davis, Jr.; a seminar in Medical Social Problems, Dr. Davis and Miss Antoinette Cannon; Social Case Work, Miss Margaret Lea); Community Organization, Mr. Walter Pettit; Human Behavior, Dr. Bernard Glueck; Stat:stics and Research, Miss Kate Claghorn, and electives in Industry,. Child Welfare, Criminology, and other subjects. Practice will be given in the clinics of Cornell Medical School and other institutions. The standard entrance requirement of the school is four years of college work. Students with less than four years of college but with graduation from an approved school of nursing may also be admitted. The full course covers two years. Credit will be given for courses and practice considered by the head of the department the equivalent of any of the above. The school issues a special bulletin on this course, which may be had from the registrar, 15 East 22nd Street, New York City. The court begins September 18, Public-Health Nursing of the American Red Cross.-The public-health nursing activities of the American Red Cross reach the rural communities where there are no other public-health activities, and no organization dealing with public-health work. It is the policy of the Red Cross, as soon as the community realizes the good done by the publichealth nurse, to ask the local authorities to take over the work. The Red Cross then moves on to another county and serves as a pioneer, almost as knight errant, in promoting simple public-health activities. It is not the desire of the Red Cross to be in competition with other agencies, or to encroach upon any function of the practicing physician. The instances where the nurses may have exceeded their authority have been few and always prompted by a humane instinct, amounting at times to compulsion, to render an imperative service without the delay required to secure medical approval. It must be remembered that some of our nurses work in localities where the nearest doctor is far away, at times as much as seventy-five miles away. The American Red Cross appreciates and respects the physician, and, almost without exception, has their active help and symnpathetic co6peration in all the communities Cross nurse does her splendid work.-johi Barton Payne, Chairman, Central Committee, Red Cross Courier, June 1, (J. A. T.)